Patient perceptions of the use of cocaine in sinonasal surgery.

Abstract

Medicinal cocaine has been used as a local anaesthetic since the 1880s, and the alkaloid is one of the first recorded anaesthetic agents. Some rhinologists use cocaine for its vasoconstriction properties to improve the endoscopic field of vision by reducing bleeding during endoscopic sinus surgery. The European Medicines Compendium advises on a maximum dose of 1.5mg/kg in fit adults (topical mucosal Cocaine Hydrochloride Solution 10% w/v) (1) (2). The addition of adrenaline will reduce systemic absorption of cocaine, lowering the solution's toxicity while simultaneously offering more significant local vasoconstriction (3). Increasing the solution's pH via sodium bicarbonate increases the anaesthetic properties while having no effect on toxicity. A solution of cocaine, adrenaline and sodium bicarbonate is eponymously termed Moffett's (4).